Use of corticosteroids in the treatment of septic arthritis in children

Report By: Jean-Sébastien Audette - PGY 3, Emergency medecine

Institution: Université Laval, Québec

Date Submitted: 22nd November 2011

Last Modified: 22nd November 2011

Status: Blue (submitted but not checked)

Three Part Question

In [children with septic arthritis] does [the addition of corticosteroids] reduce [the clinical severity or the duration of the symptoms]?

Clinical Scenario

A 3-year-old child presents to the emergency department with High fever and pain in his right knee. You perform a diagnostic arthrocentesis and the stat gram is positive. You start the IV antibiotic treatment and you wonder if the addition of a corticosteroid would be appropriate.

Search Strategy

A. No BestBETs or critical appraisal were found on this topic.
B. There was no Cochrane review found on the subject.
C. www.clinicaltrials.gov was searched for an ongoing trial on the topic, and none was found.

Search Outcome

Relevant Paper(s)

Author, date and country

Patient group

Study type (level of evidence)

Outcomes

Key results

Study Weaknesses

Odio C. and al2003Costa Rica

123 children from 3 months to 13 years old with suspected hematogenous bacterial arthritis received, with antibiotics, Dexamethasone 0,2mg/kg/dose q 8h or saline for 4 days. 100 were evaluable (50 in each group)

Double-blind randomized-control trial

Residual dysfunction of the articulation at the End of the therapy

4% (Dex) vs 32% (placebo) p = 0,00068

No primary outcome identified
23 patients not evaluated
(5 met exclusion criteria and 18 were considered non bacterial synovitis)
No mention of the side effects

Multiple primary outcomes
20 patients lost to follow-up for late sequelae
Small study
No mention of the side effects

First day pain free (primary outcome)

7.18 ± 6.46 d (Dex) vs 10.76 ± 7.20 d (placebo) p= 0.021

First day pain free (primary outcome)

7.00 ± 6.42 d (Dex) vs 12.24 ± 11.34 d (placebo) p=0.03

Presence of late sequelae (Secondary outcome)

None in the two groups

Comment(s)

There are two RCT, with methodological limitation, showing benefit of giving a Dexamethasone regimen to children with septic arthritis. The first study shows a clear reduction of residual limitation at one year and reduction of the time to resolution of the symptoms. The second RCT is a smaller study that also shows a quicker resolution of the symptoms. However, this study didn’t show difference between the two groups in the presence of late sequelae (none in each group). The potential side effects of the treatment were not reported in those two RCT.

Clinical Bottom Line

In children with septic arthritis, a regimen of dexamethasone for four days appears to reduce the duration of symptoms and could reduce the residual dysfunction of the articulation. However, a large multicentre RCT should be done to confirm the outcomes found in those two small studies with a lot of methodological weaknesses.